From the October 2017 issue of HealthCare Business News magazine
ARRTE: The Automated Radiology Recommendation Tracking Engine (University of Pennsylvania Health System)
Penn Radiology developed the Code Abdomen lexicon to more discreetly identify and describe findings of possible cancer that warranted further follow-up. Modeled on the BI-RADS classification for breast imaging, Code Abdomen consists of a numeric category with a description and, when applicable, specification of a test recommendation and timing for follow-up. Code Abdomen was introduced to keep patients from falling through the cracks who need clinically indicated follow-up after an abdominal or pelvic imaging examination.
Structured reporting was used to assist radiologists in including Code Abdomen in their abdominal and pelvic imaging reports. Templates were developed to include menus both for the numeric categories as well as for the possible test recommendations. The templates were periodically reviewed and updated, for example, to accommodate radiologists’ need to recommend additional test types.
To identify patients who had received follow-up recommendations based on their imaging results, the data within the structured templates had to be mined and analyzed. In 2013, ARRTE was developed within Penn Radiology. It includes modules for data validation, compliance checking and follow-up monitoring. ARRTE enters the patients with follow-up recommendations into a queue and monitors for completion of follow-up. If follow-up is not obtained within one month of the recommended time interval, a message is sent to the ordering physician or provider asking for additional information, such as whether they are the correct person to contact, whether or not follow-up is clinically indicated, and reasons why the patient may not have completed follow-up (e.g., additional testing was not desired, the ordering physician disagreed with the recommendation, the finding had already been followed up at an outside facility, etc.). If electronic messages cannot be sent, or responses are not received, the ordering physician is contacted by a follow-up coordinator.
To date, approximately 15 percent of patients undergoing abdominal and pelvic imaging receive follow-up recommendations within our health system. On average, approximately half of those patients have not completed their follow-up within 12 months of the recommendation, and require additional messaging to their ordering physicians to close the loop. ARRTE is maintained by a team of programmers in the Center for Translational Imaging Informatics, under the guidance of Tessa Cook, M.D., Ph.D., and Hanna Zafar, M.D., MHS.
About the authors: Dr. David Pastel is associate professor of radiology and neurology at the Geisel School of Medicine at Dartmouth in Hanover, N.H. He completed his radiology residency and a neuroradiology fellowship at Dartmouth-Hitchcock Medical Center. Dr. Tessa Cook is assistant professor of radiology at the Perelman School of Medicine at the University of Pennsylvania. She is board certified in radiology and imaging informatics, and serves as the director for the Center for Translational Imaging Informatics as well as of the Imaging Informatics Fellowship.
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